As a therapist and owner of counselling clinics in Vancouver and North Vancouver, I’m obsessed with what constitutes ‘good therapy.’ How do you know if your therapist is good? How do you know if counselling is helping you? Why does therapy sometimes work and sometimes plateau?
When we think about how effective therapy is, the research often focuses on the therapist—and for good reason! Therapists deal with clients who have complex emotional and relational struggles and show up more vulnerable with their therapists than they often do with their friends and family. This profession deserves your scrutiny.
As a therapist, I have typically been more fascinated by the counsellor’s contribution to effective therapy. But lately, I’ve had a couple of personal experiences on the flip side of being helped that led me to reflect on what clients can do to make their therapy more effective.
Transparent moment here: I am basing this partially on my own experiences in therapy. Btw, did you know that most counsellors are in therapy (and if they’re not… they should be.)
One truth about counsellors is that, well, we backseat drive a bit when we’re the client in the session. Because we are tuned into the meta-processes of what is going on in therapy, and the range of interventions used, we can be a bit analytical (dare I say…critical?) of our own therapists. And it sucks, because it keeps us stuck in our heads.
But recently, in my therapy sessions, I started paying attention to subtle moments: when something shifted, when the work landed deeper, when I wasn’t so in my head about what to say and how to express myself. And the common thread wasn’t always what my therapist said or did — it was how I was showing up.
Turns out, clients play a pretty significant role in how effective therapy can be. That’s not about shifting the blame or responsibility to clients in a punitive way — it’s actually empowering. We can shape the process, bring curiosity, and co-create something that works for us.
So, whether you are just starting counselling or have been in therapy for years, why not try out one (or more) of these strategies to help you optimize your experience in therapy – and maybe see better results!
1. Come in with something — even if it’s awkward
One of the most common moments of stuckness in therapy is the “I don’t know what to talk about” week. But ask yourself: is it that you don’t know what to talk about, or do you feel anxious or uncomfortable bringing things up? Often, what feels like nothing is actually something.
A client of mine once came into session saying, “Honestly, my mind’s a blank today.” We sat in silence for a moment, and then she added, “Although… I did have a weird moment with my sister yesterday.” That one moment, offhand, almost dismissed, became the doorway into a rich conversation about boundaries, guilt, and emotional labour in her family.
Takeaway: You don’t need to have a fully formed agenda. Give an example of a situation recently that felt off for you, or an encounter that caused a bit of friction inside. It doesn’t need to be a crisis or a major epiphany. It’s the little things that are often portals into some of our untapped feelings, needs and internal conflicts.
2. Let your therapist know what isn’t working
Many people, especially women, are socialized to be sensitive to other people’s feelings and impressions in ways that can get in the way of therapy. We might sit through sessions that feel off, confusing, or even boring, without saying anything.
But therapy isn’t a social engagement. You’re not being rude by saying, “I didn’t really connect with that exercise,” or “I noticed I shut down a bit when we talked about that.” In fact, naming those moments is therapy.
A client who had rescheduled her past few appointments and then finally came in for a session told me she’d dreaded coming in for weeks but didn’t know how to say it. When she finally did, it turned into a powerful exploration of her patterns around conflict and people-pleasing, and her therapy became way more focused and alive after that.
Takeaway: You don’t have to phrase it perfectly. You can just say, “This isn’t clicking for me,” and we’ll figure it out together.
3. Be honest about how you’re actually doing, not just how you think you should be doing
Therapy can be a space where perfectionism sneaks in through the back door. You start trying to be the “good client” — reporting progress, being insightful, saying the right things.
But therapy isn’t about being impressive. It’s about being real. The best sessions often start with someone saying, “I don’t think I’ve made any progress this week,” and then diving into all the ways they’ve been coping, surviving, numbing, or struggling.
One woman came in visibly tired, saying, “I should have done the journaling homework, but I just binge-watched Severance instead.” And guess what? That moment of honesty cracked open a deeper conversation about burnout, avoidance, and self-compassion (I’ll be honest, though, I had to work hard to resist unpacking Severance!).
Takeaway: If you’re not doing great, say so – even if you only have half-baked thoughts about why that might be. If you feel like a failure for not doing great, say so – even if you feel guilty about having ‘first-world problems’. Also, if you’re doing great, say so!
4. Use what’s happening for you in the session.
Can you imagine saying to your therapist, “Do you find me boring?” or “I feel like you want me to be angry, but I don’t feel angry, but I also don’t want to seem like I don’t know how to be in therapy!”
These are actual comments clients have said.
But the truth is, the best therapy often happens when you and your therapist are talking about thoughts, feelings, and yes, frustrations, that are occurring in real time. Including between you and the therapist. That is therapy gold.
The idea is not for your therapist to reassure you (although I am sure you are not boring!), but rather to explore the core relational and interpersonal issues at the root of your question.
A client once paused mid-session and asked me, “Do you ever get tired of hearing my stuff?” It was a brave, raw question that cracked open an important conversation about shame, attachment, and fear of being too much.
Your therapist is trained for these moments. You don’t have to protect them. In fact, bringing your fear, your doubt, or your resistance into the room can deepen the therapeutic bond — and turbocharge ‘the work’.
Takeaway: If a question is haunting you, say it out loud. It’s probably the exact thing that needs to be explored.
5. Track your change, and bring it into the room
Therapy can sometimes feel abstract. We talk, we process, we reflect. But what happens between sessions matters just as much — if not more.
Some clients find it helpful to keep a therapy journal — not a big thing, just a few notes about thoughts that came up, situations they handled differently, or things that felt hard. You can even use apps on your phone for this (I love the Notes app). One client would jot down a quick voice memo after something triggered her, and we’d use it in session the following week. It made the work sharper, more specific, and more anchored in her daily life.
Takeaway: You don’t need to document everything, but pay attention to how therapy shows up in your life. Notice when you respond to something differently than you usually would, and let your therapist in on it.
Final Thoughts
Therapy isn’t a passive process — it’s relational, dynamic, and yes, a little unpredictable. But when you show up with openness, honesty, and (especially) awkwardness, you are accelerating the session and opening a door for your therapist to do the work that really matters with you.
So the next time you’re heading into session, maybe ask yourself: How am I willing to show up today? Not as the model client, but as a person who is willing to be seen, heard, and helped.
That, more than anything, is what makes therapy work.
About the Author
Elana Sures is the owner of Open Space Counselling. She has a Masters degree in Counselling Psychology from UBC (2005) and is a Registered Clinical Counsellor and an Accredited Clinical Supervisor with the BC Association of Clinical Counsellors. Elana is a go-to expert on the psychological experiences of female high achievers.